In response to the rapidly rising intravenous opioid abuse epidemic, the United States Food and Drug Administration is currently promoting the development of prescription opioid tablets that are specifically formulated to deter abuse. Opana ER®; (Endo Pharmaceuticals) recently underwent reformulation to include a crush-resistant coating. Only recently described, illicit intravenous injection of reformulated Opana ER®; is associated with a distinctive clinical syndrome of thrombotic microangiopathy. Ten patients with the appropriate history and presenting symptoms were identified within an 8 month interval (July 2012 through February 2013) at the University of Tennessee Medical Center (UTMC) Knoxville with ICD-9 code of 446.6 (thrombotic microangiopathy) by electronic search. Review of laboratory data, electronic medical records, blood product usage, and total hospital admission charges were compiled for these individual patients.